Impact of emergency admissions on elective surgical workload

Abstract

Background: Day case surgery is the most cost-effective approach for all minor, most intermediate and some major surgery.

Aims: To examine the effect of the current 'escalation' policy of opening the surgical day ward to A&E admissions at the expense of planned surgery.

Patients and methods: A retrospective study was carried out on all elective general surgical operations planned for January through March 2003. The number of cases cancelled and the reasons for cancellation were documented.

Results: The total number of patients booked for surgery was 836, 66.6% of which were day cases (557 patients). Overall 338 patients accounting for 40.4% of all planned cases were cancelled. Day case cancellations accounted for 68.9% of all cancellations (233 patients). Bed unavailability was the main reason due to the overflow of A&E admissions, accounting for 92% of cancelled patients and 73.8% of day ward cancellations.

Conclusions: The cancellation of surgery creates untold hardship for patients who plan their working and family lives around the proposed operation date. Most are cancelled at less than 24 hours notice. The cost implications to the community are immense but have not been calculated. The separation of emergency and planned surgery is essential through adequate observation ward access.